Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Canada.
BMC Med Educ. 2020 Jul 23;20(1):235. doi: 10.1186/s12909-020-02150-0.
Best practices in managing residents in difficulty (RID) in the era of competency-based medical education (CBME) are not well described. This scoping review aimed to inventory the current literature and identify major themes in the articles that address or employ CBME as part of the identification and remediation of residents in difficulty.
Articles published between 2011 to 2017 were included if they were about postgraduate medical education, RID, and offered information to inform the structure and/or processes of CBME. All three reviewers performed a primary screening, followed by a secondary screening of abstracts of the chosen articles, and then a final comprehensive sub-analysis of the 11 articles identified as using a CBME framework.
Of 165 articles initially identified, 92 qualified for secondary screening; the 63 remaining articles underwent full-text abstracting. Ten themes were identified from the content analysis with "identification of RID" (41%) and "defining and classifying deficiencies" (30%) being the most frequent. In the CBME article sub-analysis, the most frequent themes were: need to identify RID (64%), improving assessment tools (45%), and roles and responsibilities of players involved in remediation (27%). Almost half of the CBME articles were published in 2016-2017.
Although CBME programs have been implemented for many years, articles have only recently begun specifically addressing RID within a competency framework. Much work is needed to describe the sequenced progression, tailored learning experiences, and competency-focused instruction. Finally, future research should focus on the outcomes of remediation in CBME programs.
在以能力为基础的医学教育（CBME）时代，管理有困难的住院医师（RID）的最佳实践尚未得到很好的描述。本范围综述旨在列出当前文献，并确定解决或采用 CBME 来确定和纠正有困难的住院医师的文章中的主要主题。
如果文章是关于研究生医学教育、RID 并提供了有关信息以告知 CBME 的结构和/或过程的，则在 2011 年至 2017 年期间发表的文章将被纳入。所有三位审稿人都进行了初步筛选，然后对选定文章的摘要进行了二次筛选，然后对 11 篇被确定为使用 CBME 框架的文章进行了最终全面的子分析。
最初确定的 165 篇文章中，有 92 篇符合二次筛选标准；其余 63 篇文章进行了全文摘要。通过内容分析确定了 10 个主题，其中“确定 RID”（41%）和“定义和分类缺陷”（30%）是最常见的。在 CBME 文章子分析中，最常见的主题是：需要识别 RID（64%）、改进评估工具（45%）以及参与纠正的参与者的角色和责任（27%）。近一半的 CBME 文章是在 2016-2017 年发表的。
尽管 CBME 计划已经实施了多年，但最近才开始在能力框架内专门解决 RID 问题。需要描述有序的进展、量身定制的学习体验和以能力为重点的教学。最后，未来的研究应该集中在 CBME 计划中纠正的结果上。
